Surgical clip applier

ABSTRACT

A surgical clip applier is provided including a clip pusher bar having a flexible tab and a camming plate configured to effectuate closure of the pair of jaws. The camming plate includes a lost motion portion and the flexible tab is configured to engage the lost motion portion during an initial movement of the clip pusher bar to cause the camming plate to move with the clip pusher bar. The flexible tab is configured to disengage from the lost motion portion during a subsequent movement of the clip pusher bar to allow the clip pusher bar to move relative to the camming plate.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No. 14/315,508 filed Jun. 26, 2014, now U.S. Pat. No. 9,775,624, which claims the benefit of and priority to U.S. Provisional Patent Application No. 61/870,404, filed Aug. 27, 2013, the entire disclosure of which is incorporated by reference herein.

BACKGROUND 1. Technical Field

The present application relates to surgical instruments, and more particularly, to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical procedures.

2. Discussion of Related Art

Surgical clip appliers are known in the art and have increased in popularity among surgeons by offering an alternative to conventional suturing of body tissues and vessels. Typical instruments are disclosed in U.S. Pat. No. 5,030,226 to Green et al. and U.S. Pat. No. 5,431,668 to Burbank, III et al. the entirety of each of which is incorporated herein by reference. These instruments generally provide a plurality of clips which are stored in the instrument and which are fed sequentially to the jaw mechanism at the distal end of the instrument upon opening and closing of the handles at the proximal end of the instrument. As the handles are closed, the jaws close to form a clip positioned between the jaw members, and as the jaws are opened to release the formed clip, a new clip is fed from the series of clips to a position between the jaws. This process may be repeated up to and until all the clips in the series of clips have been used.

A need exists for clip applier having simplified operation using fewer components to provide a more efficient and cost effective clip applying device without diminishing functionality.

SUMMARY

The present application relates to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical procedures and their methods of use.

According to an aspect of the present disclosure, a surgical clip applier is provided including a housing; at least one handle pivotably connected to the housing; a channel assembly extending distally from the housing; a clip carrier disposed within the channel assembly and defining a channel therein; a plurality of clips slidably disposed within the channel of the clip carrier; and a jaw assembly including a pair of jaws extending from an end of the channel assembly, opposite the housing. The jaw assembly is configured to accommodate a clip therein and is operable to effect formation of the clip in response to movement of the at least one handle. The surgical clip applier further includes a clip pusher bar slidably supported within at least one of the housing and the channel assembly. The clip pusher bar has a first end operatively connected to the at least one handle and at least one flexible tab. The surgical clip applier further includes a camming plate slidably supported within the channel assembly and configured to effectuate closure of the pair of jaws. The camming plate includes a lost motion portion and the flexible tab of the clip pusher bar is configured to engage the lost motion portion during an initial movement of the clip pusher bar to cause the camming plate to move with the clip pusher bar. The flexible tab of the clip pusher bar is configured to disengage from the lost motion portion during a subsequent movement of the clip pusher bar to allow the clip pusher bar to move relative to the camming plate.

In an aspect of the present disclosure, the lost motion portion of the camming plate includes a shoulder. The flexible tab is configured to engage the shoulder during the initial movement of the clip pusher bar and to disengage from the shoulder during the subsequent movement of the clip pusher bar.

In an aspect of the present disclosure, the lost motion portion includes a first recess and a second recess. The flexible tab is slidably disposed within the second recess during the initial movement of the clip pusher bar and is slidably disposed within the first recess during the subsequent movement of the clip pusher bar.

In an aspect of the present disclosure, the shoulder is located at a distal end of the second recess of the lost motion portion.

In an aspect of the present disclosure, the channel assembly includes a camming surface. The camming surface is configured to disengage the flexible tab from the lost motion portion after the initial movement of the clip pusher bar.

In an aspect of the present disclosure, the channel assembly includes a first recess and a second recess. The camming surface is disposed between the first and second recesses of the channel assembly. The flexible tab is configured to slide along the second recess during the initial movement of the clip pusher bar until the camming surface is reached. The flexible tab is configured to cam along the camming surface to disengage the flexible tab from the lost motion portion. The flexible tab is also configured to slide along the first recess during the subsequent movement of the clip pusher bar.

In an aspect of the present disclosure, the clip pusher bar further includes a second end that is configured to urge a clip from the plurality of clips to a location between the jaws.

In an aspect of the present disclosure, the clip pusher bar is moveable toward the jaw assembly to urge the clip from the plurality of clips to the location between the jaws and moveable away from the jaw assembly to effectuate closure of the pair of jaws.

In an aspect of the present disclosure, the camming plate is movable away from the jaw assembly as the handle is actuated in a first direction to effectuate closure of the jaws and is movable toward the jaw assembly as the handle is actuated in a second direction to effectuate opening of the jaws.

In an aspect of the present disclosure, the camming plate includes at least one camming slot and the jaws include at least one camming pin received within the camming slot of the camming plate.

In an aspect of the present disclosure, the camming pin cams along the camming slot to effectuate opening and closure of the jaws during movement of the camming plate.

In an aspect of the present disclosure, the flexible tab is distally oriented and inwardly biased against the lost motion portion of the camming plate.

In an aspect of the present disclosure, the camming plate includes a proximal flange and the clip pusher bar includes a distal window. The proximal flange of the camming plate is received within the distal window and engagable with a distal end of the distal window when the clip pusher bar moves proximally to move the camming plate proximally.

In an aspect of the present disclosure, the clip pusher bar includes at least one proximal window configured to receive a link member of the handle to provide the operative connection with the handle.

According to an aspect of the present disclosure, a method of operating a surgical clip applier is provided including the steps of actuating a handle of a clip applier an initial amount to cause an initial movement of a clip pusher bar of the clip applier in a first direction. A flexible tab of the clip pusher bar engages a shoulder of a camming plate of the clip applier to cause movement of the camming plate in the first direction. The camming plate effectuates an opening of a pair of jaws of the clip applier upon movement of the camming plate in the first direction. The method further includes actuating the handle of the clip applier a subsequent amount to cause a subsequent movement of the clip pusher bar of the clip applier in the first direction. The flexible tab disengages from the shoulder of the camming plate such that the clip pusher bar moves the subsequent amount in the first direction relative to the camming plate.

In an aspect of the present disclosure, the method includes the step of urging, by the clip pusher bar, a clip of a plurality of clips of the clip applier in between the jaws of the clip applier during the subsequent movement of the clip pusher bar in the first direction.

In an aspect of the present disclosure, during the subsequent movement of the clip pusher bar in the first direction, the method further includes the step of camming the flexible tab over a camming surface of a channel assembly of the clip applier to disengage the flexible tab from the shoulder of the camming plate.

In an aspect of the present disclosure, the method further includes the step of actuating the handle of a clip applier in an opposite direction to cause movement of the clip pusher bar in a second direction. The clip pusher bar engages the camming plate to move the camming plate in the section direction to effectuate a closing of the jaws.

In an aspect of the present disclosure, the method further includes the step of moving the camming plate in the second direction due to engagement of a proximal flange of the camming plate with a distal window of the clip pusher bar.

In an aspect of the present disclosure, when the clip pusher bar moves in the second direction, the flexible tab of the clip pusher bar is received within a recess of the camming plate proximate the shoulder. The flexible tab is biased against the recess of the camming plate.

Although the above aspects and embodiments are described separately for convenience and clarity, it is contemplated that the above aspects and embodiments may be combined without departing from the scope of the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The present clip applier will be more fully appreciated as the same becomes better understood from the following detailed description when considered in connection with the following drawings, in which:

FIG. 1 is a top, perspective view of a surgical clip applier according to an embodiment of the present disclosure;

FIG. 2A is an exploded, perspective view of a handle assembly of the surgical clip applier of FIG. 1;

FIG. 2B is a perspective view of the surgical clip applier of FIG. 1 with an upper housing half of the handle assembly and a cartridge cover of a channel assembly removed;

FIG. 2C is an enlarged view of the indicated area of detail of FIG. 2B;

FIG. 3 is an exploded perspective view of a channel assembly of the surgical clip applier of FIG. 1;

FIG. 4 is a top, perspective partial view which shows the channel assembly of the surgical clip applier of FIG. 1;

FIG. 5 is a top, perspective partial view which shows the channel assembly of FIG. 4, with the cartridge cover removed;

FIG. 6 is an exploded partial view illustrating the cartridge cover, camming plate, and clip pusher bar of the channel assembly of FIG. 4;

FIG. 7 is a partial cross-sectional view of the channel assembly of the surgical clip applier of FIG. 1 in an initial position prior to actuation of the handles of the handle assembly;

FIG. 8 is a partial cross-sectional view of the channel assembly of the surgical clip applier of FIG. 1 during an initial actuation of the handles;

FIG. 9 is a partial cross-sectional view of the channel assembly of the surgical clip applier of FIG. 1 during a subsequent actuation of the handles; and

FIG. 10 is a partial cross-sectional view of the channel assembly of the surgical clip applier of FIG. 1 in a final position with handles fully actuated.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of surgical clip appliers in accordance with the present disclosure will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical structural elements. As shown in the drawings and described throughout the following description, as is traditional when referring to relative positioning on a surgical instrument, the term “proximal” refers to the end of the apparatus which is closer to the user and the term “distal” refers to the end of the apparatus which is further away from the user.

Referring now to FIGS. 1-3, a surgical clip applier in accordance with an embodiment of the present disclosure is generally designated as 100. Surgical clip applier 100 generally includes a handle assembly 102 including a housing 104 having an upper housing half 104 a and lower housing half 104 b. Handle assembly 102 further includes a pair of handles 106 pivotably secured to housing 104 and extending outwardly therefrom. A channel assembly 108 is fixedly secured to housing 104 and extends distally therefrom, terminating in a jaw assembly 110 supported in a distal end of channel assembly 108. As seen in FIGS. 1 and 2A-2C, housing halves 104 a and 104 b of clip applier 100 fit together by, e.g., snap fit engagement with one another. Alternatively, housing halves 104 a and 104 b may be joined through any manner including, for example, one or more screws, fasteners and the like, through the use of glues, or other adhesives, or through the use of plastic or radiofrequency welding.

As can be seen in FIGS. 1 and 2A-2C, handles 106 are secured to housing 104 by handle pivot pins 104 d extending between lower housing half 104 b and upper housing half 104 a through respective apertures 106 a formed in handles 106. Handle assembly 102 includes a link member 112 pivotally connected to each handle 106 at a pivot point 114 formed in a respective handle 106. A proximal end 112 a of each link member 112 includes a hooked or G-shaped portion 112 b that is pivotally connected to clip pusher bar 160. In use, as will be described in greater detail below, as handles 106 are squeezed, link members 112 push pusher bar 160 proximally.

Referring now to FIGS. 1, 2B-2C, and 3, channel assembly 108 includes a channel or cartridge cover 130 and an outer or lower channel 132 each having a proximal end retained in housing assembly 102, between upper and lower housing halves 104 a, 104 b.

Clip applier 100 further includes a clip pusher bar 160 that is reciprocally supported in and extends between handle assembly 102 and channel assembly 108. A proximal portion of pusher bar 160 is supported between upper and lower housing halves 104 a, 104 b of housing 104 and a distal portion of pusher bar 160 is supported between cartridge cover 130 and outer channel 132 of channel assembly 108.

Referring now to FIGS. 3-6, pusher bar 160 includes a lower wall 160 a and first and second side walls 160 b, 160 c extending from the lower wall 160 a. Lower wall 160 a and side walls 160 b, 160 c together define a channel 160 d extending along at least a portion of the pusher bar 160 for at least partial reception of jaw assembly 110, a clip carrier 170, a clip follower 174, a clip spring 176 and a camming plate 180 therein.

Referring now to FIGS. 2B, 2C, and 3, first and second side walls 160 b and 160 c each include a pair of proximal windows 166 and 168 at a proximal end 160 f for the reception of hooks 112 b of linkage members 112. Proximal windows 166 and 168 include a pivot bar 168 a disposed therebetween about which the linkage members 112 pivot during actuation of handles 106. Each pivot bar 168 a is received within an opening 112 c of the hook 112 b of one of the linkage members 112 to pivotably secure the linkage member 112 to the pusher bar 160.

Referring again to FIGS. 3-6, first and second side walls 160 b, 160 c each include a distally oriented flexible tab 162 at a distal portion 160 e and a distal window 164 which are proximal of the flexible tab 162. It is contemplated that distal windows 164 may alternatively be disposed distal of flexible tabs 162.

Pusher bar 160 further includes a distal end 160 g extending distally of distal portion 160 e defining a pusher 160 h configured and adapted to selectively engage/move a distal-most clip “C1” of a stack of clips “C” stored in surgical clip applier 100. In an embodiment, distal end 160 g of pusher bar 160 includes side walls 160 i and 160 j extending from lower wall 160 a and defining a channel 160 k for the reception of a distal portion of a clip carrier 170. In some embodiments, the side walls 160 i and 160 j extend a first height from lower wall 160 a, and the side walls 160 b and 160 c extend a second height from lower wall 160 a. In some embodiments, the first height of side walls 160 i and 160 j is less than the second height of side walls 160 b and 160 c.

With reference to FIG. 3, clip applier 100 further includes a clip carrier 170 disposed within channel assembly 108 and within the channel 160 d of pusher bar 160. Clip carrier 170 is a generally box-like structure having an upper wall 170 a, a pair of side walls 170 b and a lower wall 170 c defining a channel 170 d therethrough.

A stack of surgical clips “C” is loaded and/or retained within channel 170 d of clip carrier 170 in a manner so as to slide therewithin and/or therealong. The clips of the plurality of surgical clips “C” are arranged in tip-to-tail fashion within channel 170 d. Clip carrier 170 further includes a tab 170 e at a distal end of channel 170 d for maintaining the distal most clip “C1” in place. Clip carrier 170 further includes a fin 170 f extending from a top surface thereof for engaging cartridge cover 130 to inhibit longitudinal movement of clip carrier 170 relative to cartridge cover 130. Clip carrier 170 further includes a tab 170 g for engaging an opening 176 b of clip spring 176.

With further reference to FIG. 3, clip applier 100 further includes a clip follower 174 slidably disposed within channel 170 d of clip carrier 170. As will be discussed in greater detail below, clip follower 174 is positioned behind the stack of surgical clips “C” and is provided to urge the stack of clips “C” forward during an actuation of clip applier 100. Clip follower 174 is biased distally against the stack of clips “C” by a clip spring 176. Spring 176 may take the form of a constant force spring or other comparable biasing element. A distal end 176 a of clip spring 176 is fixedly attached or secured to clip carrier 170 by insertion of tab 170 g of clip carrier 170 into opening 176 b of clip spring 176. Clip spring 176 may be fixedly attached to clip carrier 170 or any other fixed surface of clip applier 100 and may be fixedly attached in any manner including, for example, one or more screws, fasteners and the like, through the use of glues, or other adhesives, or through the use of plastic or radiofrequency welding. A proximal portion 176 c of clip spring 176 is wound around a spool 176 d secured against a proximal end 174 a of clip follower 174. In an embodiment, clip follower 174 includes a flange 174 b at the proximal end 174 a for engaging spool 176 c. Spool 176 c is biased against flange 174 b by clip spring 176 to bias clip follower 174 against the stack of clips “C”.

During actuation of clip applier 100, as clips “C” are used and the number of clips “C” remaining in clip carrier 170 is reduced, with distal end 176 a of spring 176 fixedly secured in place, spring 176 winds-up around spool 176 c to urge clip follower 174 distally against the stack of clips “C” and bias or move the stack of clips “C” within clip carrier 170.

As can be seen in FIGS. 1 and 3, jaw assembly 110 includes a pair of jaws 120 mounted on or at a distal end of channel assembly 108 and actuatable by handles 106 of handle assembly 102. Jaws 120 are formed of a suitable biocompatible material such as, for example, stainless steel or titanium.

Jaws 120 are mounted in a distal end of housing 108 such that jaws 120 are longitudinally stationary relative to outer channel 132. As seen in FIGS. 1, 2B-2C, and 3, jaws 120 define a channel 120 a therebetween for receipt of a surgical clip “C” therein. Each jaw 120 further includes a respective camming pin 120 b, 120 c projecting therefrom.

As can be seen in FIGS. 3, 5 and 6, jaw assembly 110 further includes a camming plate 180 disposed within housing 108. Camming plate 180 is slidably received within channel 160 a of pusher bar 160 and includes a distal end 180 a having first and second camming slots 180 b, 180 c that slidably receive camming pins 120 b, 120 c of jaws 120, respectively. Camming plate 180 is configured to actuate the jaws 120 upon actuation of handles 106.

During actuation of clip applier 100, as camming plate 180 moves proximally, camming pins 120 b, 120 c of jaws 120 travel along camming slots 180 b, 180 c of camming plate 180 to effectuate closure of the jaws 120 and to form the distal most clip “C1” located or loaded between the jaws 120.

Camming plate 180 further includes a lost motion section 182 having a first recessed portion 182 a defining a first shoulder 182 b at a distal end thereof, and a second recessed portion 182 c recessed relative to the first recess portion 182 a and defining a second shoulder 182 d at a distal end thereof. First and second recessed portions 182 a and 182 c are configured and dimensioned to slidably receive flexible tabs 162 of pusher bar 160 therein during actuation of clip applier 100. Flexible tabs 162 of pusher 160 are distally oriented and inwardly biased such that when pusher bar 160 and camming plate 180 are in a proximal most position (FIG. 9), flexible tabs 162 are biased against second recessed portion 182 c, proximal of or abutting second shoulder 182 d thereof. In this manner, as pusher bar 160 moves distally, flexible tabs 162 engage against second shoulder 182 d and drive camming plate 180 distally.

Camming plate 180 further includes a proximal flange 180 e at a proximal end 180 f thereof. Proximal flange 180 e is slidably received within windows 164 of pusher bar 160. During actuation of clip applier 100, as pusher bar 160 is moved proximally, proximal flange 180 e of camming plate 180 engages a distal end 164 a of each window 164 to also move camming plate 180 proximally.

Referring now to FIGS. 3-6, cartridge cover 130 further includes first recessed portions 130 a, and second recessed portions 130 b recessed relative to the first recessed portions 130 a. Between the first and second recessed portions 130 a, 130 b are camming surfaces 130 c which are configured to engage against the flexible tabs 162 of pusher bar 160 during distal movement of pusher bar 160 to urge flexible tabs 162 out of second recessed portion 182 c of camming plate 180 and into first recessed portion 182 a of camming plate 180 to allow the pusher bar 160 to advance distally relative to camming plate 180 to thereby position the distal most clip “C1” between the jaws 120. Thus, when distal ends 162 a of flexible tabs 162 are engaged against camming surfaces 130 c and slide along camming surfaces 130 c, flexible tabs 162 are disengaged from second shoulders 182 d of camming plate 180.

Surgical clip applier 100 may include a lockout mechanism (not shown) disposed in channel assembly 108. The lockout mechanism may be actuated by clip follower 174 when a proximal most or final clip “C3” (FIG. 3) is expelled from clip applier 100. The lockout mechanism may be urged by clip follower 174 to extend across a path of pusher bar 160, thereby preventing pusher bar 160 from moving proximally and/or distally. Examples of a variety of suitable lockout mechanisms, for use in clip applier 100, can be found in U.S. Patent Publication No. 2010/0049216, filed on Aug. 13, 2009, entitled “Surgical Clip Applier and Method of Assembly,” the entirety of which is incorporated herein by reference.

Surgical clip applier 100 may further include a counter mechanism (not shown) supported in at least one of the housing 104 and the channel assembly 108. The counter mechanism may be configured and adapted to display a change in the clip applier, e.g., increment or decrement, upon each actuation of handles 106. An example of a suitable counter mechanism, for use in clip applier 100, can be found in U.S. Patent Publication No. 2010/0049216, filed on Aug. 13, 2009, entitled “Surgical Clip Applier and Method of Assembly,” the entirety of which is incorporated herein by reference.

Surgical clip applier 100 may further include a ratchet mechanism (not shown) including a rack having a plurality of teeth and a pawl having at least one tooth and configured to selectively engage the rack. The ratchet mechanism may be configured to inhibit inadvertent return of the pusher bar 160 before full actuation of the handles 106. An example of a suitable ratchet mechanism, for use in clip applier 100, can be found in U.S. Patent Publication No. 2010/0049216, filed on Aug. 13, 2009, entitled “Surgical Clip Applier and Method of Assembly,” the entirety of which is incorporated herein by reference.

Surgical clip applier 100 may further include a pusher bar biasing member (not shown) configured to bias pusher bar 160 distally and maintain the handles 106 in an un-squeezed condition absent an applied closing force. An example of a similar biasing member, for use in clip applier 100, which can provide a compression or tension force against clip pusher bar to bias clip pusher bar distally can be found in U.S. Patent Publication No. 2010/0049216, filed on Aug. 13, 2009, entitled “Surgical Clip Applier and Method of Assembly,” the entirety of which is incorporated herein by reference.

With reference to FIGS. 2B-2C and 7-10, the operation of the clip applier 100 is provided. Referring now to FIGS. 2B and 7, prior to any initial squeezing of handles 106 of clip applier 100, in an initial or original position, with a first of clips “C” loaded into the jaws 120, the pusher bar 160 and camming plate 180 are each located in a distal-most position with flexible tabs 162 of pusher bar 160 disposed in first recessed portion 182 a of camming plate 180 and abutting or proximate to first shoulder 182 b thereof. With reference to FIG. 6, in the initial or original position, proximal flange 180 e of camming plate 180 is located at the proximal end of window 164 of pusher bar 160.

Referring now to FIGS. 2B, 8 and 9, the operation associated with an initial squeezing of handles 106 of clip applier 100 will be described. As illustrated in FIG. 2C, as handles 106 are squeezed an initial amount, link members 112 push pusher bar 160 proximally.

As illustrated in FIGS. 8 and 9, during the initial squeezing of handles 106, as pusher bar 160 translates proximally, flexible tabs 162 slide proximally along first recessed portion 182 a of camming member 180 and first recessed portion 130 a of cartridge cover 130 until flexible tabs 162 reach camming surfaces 130 c of cartridge cover 130. As flexible tabs 162 slide over camming surfaces 130 c, flexible tabs 162 engage against second recessed portion 182 c of camming member 180 proximal of second shoulder 182 d and second recessed portion 130 b of cartridge cover 130 due to the inward biasing of flexible tabs 162.

As pusher bar 160 continues to translate proximally, proximal flange 180 e of camming plate 180 engages distal end 164 a of window 164 of pusher bar 160 thereby causing camming plate 180 to also translate proximally.

Referring now to FIGS. 9 and 10, the operation associated with a further continued squeezing of handles 106 of clip applier 100 will be described. As handles 106 are squeezed a subsequent amount, pusher bar 160 continues to translate proximally. As pusher bar 160 translates proximally, camming plate 180 translates proximally due to the engagement of flange 180 e thereof with the distal end 164 a of each window 164, and camming pins 120 b and 120 c of jaw assembly 110 travel along camming slots 180 b and 180 c of camming plate 180 to actuate the jaws 120 from an open configuration with camming pins 120 b and 120 c space apart (FIG. 7) to a closed configuration with camming pins 120 b and 120 c approximated toward one another (FIG. 10) to form a surgical clip “C” positioned within the jaws 120.

Referring now to FIG. 10, the state of clip applier 100 with handles 106 in the fully squeezed position will now be described. As illustrated in FIG. 10, with handles 106 in the fully squeezed position, pusher bar 160 and camming plate 180 are at proximal most positions with camming pins 120 b and 120 c at the distal end of camming slots 180 b and 180 c, respectively, with jaws 120 approximated together in the closed configuration to form a clip “C” disposed between jaws 120 about tissue or a vessel. Flexible tabs 162 of pusher bar 160 are biased against second recessed portion 180 c of camming plate 180 and second recessed portion 130 b of cartridge cover 130 with the distal end 162 a of flexible tabs 162 located proximal of second shoulder 182 d and camming surfaces 130 c. In the fully squeezed position, proximal flange 180 e of camming plate 180 is located at a distal end 164 a of distal window 164 a.

Once the distal most clip “C1” has been formed about the tissue or vessel, handles 106 are released or un-squeezed. With reference to FIGS. 6-10 in reverse order, the operation associated with the releasing of handles 106 will now be described.

As illustrated in FIG. 2C, as handles 106 are released an initial amount, link members 112 pull pusher bar 160 distally.

As illustrated in FIGS. 9 and 10, during the initial release of handles 106, as pusher bar 160 translates distally, distal ends 162 a of flexible tabs 162 engage against second shoulders 182 d of camming plate 180 to also move camming plate 180 distally. As camming plate 180 moves distally, pins 120 b and 120 c of jaws 120 travel proximally along to camming slots 180 b and 180 c to begin opening or un-approximating jaws 120.

As illustrated in FIGS. 8 and 9, during continued releasing of handles 106, as pusher bar 160 and camming plate 180 continue to move distally, camming pins 120 b and 120 c of jaws 120 reach the proximal ends of camming slots 180 b and 180 c and the jaws 120 are in an un-approximated or open configuration and ready to receive the next clip “C”.

During the further releasing of handles 106, as pusher bar 160 moves distally relative to cartridge cover 130, distal ends 162 a of flexible tabs 162 slide along camming surfaces 130 c of cartridge cover 130 and are flexed outward relative to second recess 182 c of camming plate 180 and second recess 130 b of cartridge cover 130 and into first recess 182 a of camming plate 180 and first recess 130 a of cartridge cover 130. In this manner distal ends 162 a of flexible tabs 162 are disengaged from second shoulder 182 d of camming plate 180.

As illustrated in FIGS. 7 and 8, during a further continued releasing of handles 106 pusher bar 160 continues to translate distally with distal ends 162 a of flexible tabs 162 sliding along first recess 182 a of camming plate 180 and first recess 130 a of cartridge cover 130. Because distal ends 162 a of flexible tabs 162 are no longer engaged against second shoulder 182 d of camming plate 180, camming plate 180 is no longer translated distally by pusher bar 160 and pusher bar 160 is allowed to further translate distally relative to camming plate 180.

During the continued distal translation of pusher bar 160, pusher 160 h engages a new distal most clip “C2” and urges the new distal most clip “C2” between jaws 120. Once the new distal most clip “C2” has been urged between jaws 120, clip follower 174 advances the stack of clips “C” due to the biasing of clip biasing member 176.

Once handles 106 have been fully released, clip applier 100 has been returned to the initial or original position with clip “C2” loaded between jaws 120 and pusher bar 160 and camming plate 180 in the distal most positions. The clip applier 100 is now ready to apply and form clip “C2” to tissue or another vessel in the manner described above for clip “C1”.

It should be understood that the foregoing description is only illustrative of the present disclosure. Various alternatives and modifications can be devised by those skilled in the art without departing from the disclosure. Accordingly, the present disclosure is intended to embrace all such alternatives, modifications and variances. The embodiments described with reference to the attached drawing figures are presented only to demonstrate certain examples of the disclosure. Other elements, steps, methods and techniques that are insubstantially different from those described above and/or in the appended claims are also intended to be within the scope of the disclosure. 

What is claimed is:
 1. A method of operating a surgical clip applier comprising: actuating a handle of the clip applier in a first handle direction by an initial amount to cause an initial movement of a clip pusher bar of the clip applier in a first clip-pusher-bar direction, such that a flexible tab of the clip pusher bar engages a shoulder of a camming plate of the clip applier to cause movement of the camming plate in the first clip-pusher-bar direction, the camming plate effectuating an opening of a pair of jaws of the clip applier upon movement of the camming plate in the first clip-pusher-bar direction; actuating the handle of the clip applier in the first handle direction by a subsequent amount to cause a subsequent movement of the clip pusher bar of the clip applier in the first clip-pusher-bar direction, such that the flexible tab disengages from the shoulder of the camming plate such that the clip pusher bar moves the subsequent amount in the first clip-pusher-bar direction relative to the camming plate; actuating the handle of the clip applier in a second handle direction, opposite to the first handle direction, to cause movement of the clip pusher bar in a second clip-pusher-bar direction and engaging the camming plate with the clip pusher bar to move the camming plate in the second clip-pusher-bar direction to effectuate closing of the pair of jaws; and moving the camming plate in the second clip-pusher-bar direction due to engagement of a proximal flange of the camming plate with a distal window of the clip pusher bar.
 2. The method of claim 1, further comprising: urging, by the clip pusher bar, a clip of a plurality of clips of the clip applier in between the pair of jaws of the clip applier during the subsequent movement of the clip pusher bar in the first clip-pusher-bar direction.
 3. The method of claim 1, wherein during the subsequent movement of the clip pusher bar in the first clip-pusher-bar direction, the method further comprising: camming the flexible tab over a camming surface of a channel assembly of the clip applier and disengaging the flexible tab from the shoulder of the camming plate.
 4. The method of claim 1, wherein when the clip pusher bar moves in the second clip-pusher-bar direction, the method further comprising: receiving the flexible tab of the clip pusher bar within a recess of the camming plate proximate the shoulder and biasing the flexible tab against the recess of the camming plate.
 5. The method of claim 1, further comprising: locating a distal end portion of the distal window of the clip pusher bar adjacent the proximal flange of the camming plate to move the camming plate in the second clip-pusher-bar direction.
 6. A method of operating a surgical clip applier, comprising: moving a clip pusher bar of the clip applier a first initial amount in a first direction and engaging a lost motion portion of a camming plate of the clip applier with a flexible tab of the clip pusher bar to cause movement of the camming plate in the first direction and effectuating an opening of a pair of jaws of a jaw assembly of the clip applier upon movement of the camming plate in the first direction; moving the clip pusher bar of the clip applier a first subsequent amount in the first direction and engaging a camming surface of the clip applier with the flexible tab of the clip pusher bar such that the flexible tab disengages from the lost motion portion of the camming plate to allow the clip pusher bar to move the first subsequent amount in the first direction relative to the camming plate; engaging a first shoulder of the lost motion portion between a first recess and a second recess of the lost motion portion of the camming plate while the flexible tab of the clip pusher bar is positioned within the first recess to cause movement of the camming plate in the first direction; and sliding the flexible tab of the clip pusher bar along the camming surface of the clip applier and flexing the flexible tab outward relative to the first recess of the lost motion portion of the camming plate to disengage the flexible tab from the first shoulder of the lost motion portion.
 7. The method of claim 6, further comprising: sliding the flexible tab of the clip pusher bar along the second recess of the lost motion portion of the camming plate towards a second shoulder at a distal end portion of the second recess and moving the clip pusher bar the first subsequent amount in the first direction relative to the camming plate.
 8. The method of claim 7, further comprising: moving the clip pusher bar relative to the camming plate a second initial amount in a second direction, opposite from the first direction, while the flexible tab of the clip pusher bar is positioned within the second recess of the lost motion portion of the camming plate, and sliding the flexible tab along the camming surface of the clip applier to position the flexible tab within the first recess of the lost motion portion of the camming plate.
 9. The method of claim 8, further comprising: moving the clip pusher bar a second subsequent amount in the second direction; and engaging a proximal flange of the camming plate with a distal end portion of a window of the clip pusher bar to move the camming plate in the second direction with the clip pusher bar.
 10. The method of claim 9, further comprising: sliding a pair of camming pins of the jaw assembly along a corresponding pair of camming slots of the camming plate in the first direction as the camming plate moves in the second direction; and moving the pair of camming pins of the jaw assembly from a spaced-apart position towards an approximated position to effectuate closing of the pair of jaws of the jaw assembly. 